摘要
目的:比较左侧乳腺癌保乳术后自由呼吸、吸气末屏气两种呼吸模式下放射治疗计划的靶区、心脏、冠状动脉左前降支、左肺以及右侧乳腺等危及器官的剂量参数,探索在左侧乳腺癌保乳放疗中能最大程度减少靶区周围重要组织器官受照体积和剂量的呼吸模式。方法:选取左侧乳腺癌保乳术后的患者10例,年龄38~65岁,采用乳腺托架进行体位固定。用Philips Brilliance 16排大孔径CT定位机进行图像扫描,扫描层厚3 mm,分别采集自由呼吸(free breath,FB)、吸气末屏气(inspiration breath hold,IBH)两种呼吸模式下的CT图像。将CT图像传输到Varian Eclipse治疗计划系统进行图像重建,勾画靶区及危及器官,分别设计两种呼吸模式下的6野调强计划,比较两种呼吸模式下的靶区和危及器官剂量学参数。结果:FB、IBH两种呼吸模式下,靶区的最大剂量、平均剂量、均匀指数及体积差异均无统计学意义(P>0.05)。FB、IBH两种呼吸模式下危及器官受量对于心脏:Dmax分别为(46.61±1.68)Gy、(39.29±8.40)Gy,Dmean分别为(6.74±4.00)Gy、(5.39±4.12)Gy,差异均有统计学意义(P<0.05);V5、V10、V20、V30的差异也均有统计学意义(P<0.05)。冠状动脉左前降支(LAD):Dmax分别为(39.64±4.31)Gy、(30.54±9.08)Gy, Dmean分别为(31.21±7.70)Gy、(22.72±9.36)Gy,差异均有统计学意义(P<0.05)。左肺:Dmean分别为(9.11±2.61)Gy、(8.74±2.01)Gy,差异无统计学意义(P> 0. 05);V5、V10、V20、V30的差异也均无统计学意义(P> 0. 05)。右侧乳腺:Dmax分别为(4. 76±1. 94)Gy、(5. 06±2. 15)Gy,Dm ean分别为(1. 32±1. 01)Gy、(1. 30±0. 94)Gy,差异均无统计学意义(P> 0. 05)。结论:左侧乳腺癌保乳术后两种呼吸模式计划比较,靶区受照剂量、左肺受照剂量及右侧乳腺受照剂量均无明显差异。吸气末屏气技术明显降低了心脏、LAD的受照剂量。
Objective:To compare the dosimetric parameters of planning target volume(PTV),heart,left anterior descending coronary artery(LAD),left lung,right breast and other organs at risk(OAR) between two breath modes(free breath:FB,inspiration breath hold:IBH) for left-side breast cancer after breast-conserving surgery and to explore the optimal breath method in the postoperative radiotherapy of left-side breast cancer patients with minimum dose to normal tissues and organs at risk.Methods:10 patients of left-side breast cancer after breast-conserving surgery were selected,aged 38~65 years old,using breast bracket for positioning.All patients were scanned by Philips Brilliance 16 rows big bore CT simulation with 3 mm thickness.Two CT simulation scans with two different breath hold methods(FB,IBH) were performed for each patient.After scanning,the image was transmitted into Varian Eclipse treatment planning system for reconstruction,and the target volume and organs at risk were delineated.The IMRT plan with 6 fields was designed.Dosimetric differences were compared between two different breath modes.Results:There was no significant in the target volume,max dose,mean dose and homogeneity of PTV among plans generated from two different image sets(P>0.05).The max heart dose,max LAD dose,and max right breast dose in plans generated from CT image sets with FB,IBH were(46.61±1.68)Gy,(39.29±8.40)Gy(P<0.05),(39.64±4.31)Gy,(30.54±9.08)Gy(P<0.05),and(4.76±1.94)Gy,(5.06±2.15)Gy(P>0.05),respectively.The mean heart dose,mean LAD dose,mean left lung dose and mean right breast dose in plans generated from CT image sets with FB,IBH were(6.74±4.00)Gy,(5.39±4.12)Gy(P<0.05),(31.21±7.70)Gy,(22.72±9.36)Gy(P<0.05),(9.11±2.61)Gy,(8.74±2.01)Gy(P>0.05),and(1.32±1.01)Gy,(1.30±0.94)Gy(P>0.05),respectively.The significant difference was found in the V5,V10,V20,V30 of heart(P<0.05).There was no significant in the V5,V10,V20,V30 of left lung(P>0.05).Conclusion:Through the plan of two breath modes for left-side breast cancer after breast-conserving surgery,there was no obvious difference for the target volume,left lung and right breast doses.Plans with IBH achieve lower heart and LAD doses.
作者
高文超
王军良
曹井丽
王超
孙冰
史三忠
吴世凯
Gao Wenchao;Wang Junliang;Cao Jingli;Wang Chao;Sun Bing;Shi Sanzhong;Wu Shikai(Department of Radiation Oncology, the Fifth Medical Center of PLA General Hospital(the 307th Hospital of PLA),Beijing 100071,China)
出处
《现代肿瘤医学》
CAS
2019年第20期3699-3702,共4页
Journal of Modern Oncology
关键词
左侧乳腺癌
呼吸模式
剂量学参数
left-side breast cancer
breath modes
dosimetric parameters
